Provider Demographics
NPI:1811548365
Name:SIMMONS, SHIRLEY
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:WV
Mailing Address - Zip Code:26292-0389
Mailing Address - Country:US
Mailing Address - Phone:304-463-4819
Mailing Address - Fax:
Practice Address - Street 1:295 PIERCE-BENBUSH ROAD
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:WV
Practice Address - Zip Code:26292-0389
Practice Address - Country:US
Practice Address - Phone:304-463-4819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider